摘要:

BackgroundVolume Expansion (VE) results in both natriuresis and a phosphaturia. In previous studies, Sprague-Dawley rats were infused with a modified saline solution. The expansion procedure resulted in a 70% increase in the phosphorylation of a 72 kDa proximal tubular brush border membrane (BBM) protein. In recent experiments, Sprague-Dawley rats were subjected to the same short term VE. For both control and VE animals, brush border membrane vesicles (BBMV) were obtained.Methods and ResultsMass spectrometry of 3 proteins in the size range of our phosphoprotein resulted in the identification of ezrin/villin2, moesin, and PDZ domain-containing 1 (PDZ-dc1). Diphor-1 (currently renamed PDZ-dc1) is involved in regulation of the type II Na/Pi cotransporter. Ezrin and moesin are membrane-cytoskeletal linking proteins that are involved in the regulation of the sodium-hydrogen exchanger (NHE3) via interactions with another PDZ protein identified as sodium-hydrogen exchanger regulatory factor (EBP50, NHERF). Ezrin, moesin, and PDZ-dc1 protein levels were not increased following short term VE. Two-dimensional electrophoresis of our phosphorylated BBM proteins, followed by MALDI/MS analysis resulted in the identification of a protein mixture containing ezrin/moesin, alkaline phosphatase, and an unknown protein. Based on Western and immunoprecipitation data for ezrin, moesin, and PDZ-dc1 we believe that it is unlikely that our phosphoprotein is any of these 3 proteins. Parallels between NHE3 regulation (through EBP50/ERM proteins) and Na/Pi cotransporter regulation (through PDZ-dc1/ERM proteins) may be drawn.ConclusionThese changes in proximal Na/Pi cotransport may involve a signal transduction cascade including PDZ-dc1, ezrin, moesin, our phosphoprotein, and possibly other proteins.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundEmpyema thoracis (ET) is associated with substantial morbidity and mortality. The optimal means for draining the pleural space remains controversial but there may be increasing bias for less invasive strategies. This study compared outcome after a nonsurgical versus a surgical approach to ET.MethodsPatients with ET over a 10-year period (n = 93) were reviewed and stratified into nonsurgical (thoracentesis and/or closed tube thoracostomy) and surgical (thoracotomy, decortication, and/or open window thoracostomy) groups based on pleural drainage techniques. Hospital course was analyzed except when altered by death (n = 12), noncompliance (n = 3), or severe comorbidities (n = 3).ResultsSeventy-five patients were stratified into nonsurgical (n = 32) and surgical (n = 43) groups. Demographics, comorbidities, signs and symptoms, and causative organisms were similar between groups. Mortality did not significantly differ in nonsurgical (16%) versus surgical (10%) groups (P= 0.7). Although delay in diagnosis and number of therapeutic interventions were nearly identical, the time to definitive therapy was longer in the surgical versus the nonsurgical group (18 ± 3.8 versus 8.5 ± 3.8 days,P= 0.023). The time to discharge after definitive therapy (20.0 ± 3.5 versus 35.6 ± 14.0 days,P< 0.001), and overall hospital stay (40.6 ± 5.3 versus 47.4 ± 15 days,P= 0.01) was significantly decreased in the surgical versus nonsurgical treatment groups, respectively.ConclusionThe treatment of ET is complex. Failure to adequately evacuate the pleural space and/or persistent signs of infection should prompt surgical intervention. Surgical therapy is preferred for advanced stages of ET. Delaying definitive surgical treatment is largely responsible for prolonging hospital course.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

The renin-angiotensin-aldosterone system (RAAS) plays an integral role in maintaining vascular tone, optimal salt and water homeostasis, and cardiac function in humans. However, it has been recognized in recent years that pathologic consequences may also result from overactivity of the RAAS. Clinical disease states such as renal artery stenosis, hypertension, diabetic and nondiabetic nephropathies, left ventricular hypertrophy, coronary atherosclerosis, myocardial infarction, and congestive heart failure (CHF) are examples. Part of the adverse cardiorenal effects of the RAAS may be related to the prominent role that this system plays in the activation of the sympathetic nervous system, the dysregulation of endothelial function and progression of atherosclerosis, as well as inhibition of the fibrinolytic system. Also, direct profibrotic actions of angiotensin II and aldosterone in the kidney and heart promote end organ injury. Current basic science and clinical research supports the use of inhibitors of the RAAS, including angiotensin converting enzyme inhibitors, angiotensin receptor blockers, and aldosterone antagonists in treating hypertension, improving diabetic nephropathy and other forms of chronic kidney disease, preventing or ameliorating CHF, and optimizing prognosis after myocardial infarction.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Inadequate treatment of severe hyponatremia (<120 mEq/L) can be associated with severe neurological damage. In acute (<48 hours) hyponatremia, usually observed in the postoperative period, prompt treatment with hypertonic saline (3%) can prevent seizures and respiratory arrest. For patients with chronic (>48–72 hours) symptomatic hyponatremia, correction must be rapid during the first few hours (to decrease brain edema) followed by a slow correction limited to 10 mmol/L over 24 hours to avoid the development of osmotic demyelinating syndrome. In patients with asymptomatic hyponatremia, slow correction is the appropriate approach. When patients are overtreated, neurologic damage can be prevented by relowering the serum sodium (SNa) so that the daily increase in SNa remains below 10 mmol/L/24 hours. Frequent measurements of SNa during the correction phase of SNa are mandatory to avoid overcorrection. The use of urea to treat hyponatremia represents an advantageous alternative to hypertonic saline.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

BackgroundApproximately 20% of cerebral infarctions are caused by a cardiac source of embolism. Although transesophageal echocardiography (TEE) is a valuable tool for evaluating patients with suspected cardioembolism, its use should be more selective.ObjectiveWe attempted to determine whether risk factors derived from the clinical, ECG, and transthoracic echocardiogram (TTE) would make TEE use more selective and increase its yield.MethodsWe retrospectively reviewed the records of 108 patients with suspected embolic stroke who had undergone TEE evaluation. We defined the presence of left atrial appendage spontaneous contrast (LAASC), left atrial appendage thrombus (LAAT), patent foramen ovale (PFO), or intraatrial septal aneurysm (IASA) as TEE endpoints suggestive of cardioembolism. We evaluated the association between the TEE endpoints and (1) age greater than 60 years, (2) the presence of atrial flutter (AFl) or atrial fibrillation (AF) on ECG, (3) left ventricular (LV) dysfunction by TTE (mild, LVEF < 40%; severe, LVEF < 25%), and (4) left atrial (LA) size > 4 cm also determined by TTE. The statistical analysis performed was one-way analysis of variance controlling for interactions between different risk factors and the endpoints.ResultsThe strongest independent predictors for the presence of LAASC or LAAT were age greater than 60 years, presence of AFl/AF, and LV systolic dysfunction. There was no association between any of the risk factors with the presence of PFO or IASA.ConclusionThis study demonstrates that clinical characteristics, ECG, and TTE findings can help to better select stroke patients for TEE. Future larger studies are needed to provide more supporting data.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Cancer from an unknown primary site (CUP) is frequently encountered in clinical practice. This review is designed to help physicians identify those patients with CUP that benefit from specific therapeutic approaches. The utility of pathologic and diagnostic tests in patients with CUP will also be discussed, as will the prognosis and appropriate treatment of these patients.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

We present a 75-year-old patient with recurrent palpable purpura and multiorgan involvement by leukocytoclastic vasculitis caused by mixed-type cryoglobulinemia. The disease spanned 40 years, with many flare-ups, each associated with thrombocytopenia, and finally culminated in widespread involvement of not only the skin and the kidneys but also the lungs and spleen. Despite extensive investigation, no association with hepatitis C virus or with any malignant or connective tissue disorder was found.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID

摘要:

Splenic metastases are infrequent, and determination of the primary site by fine-needle aspiration (FNA) can be complex. We report the case of a 65-year-old man who was found to have a large heterogeneously enhancing 8 × 7-inch splenic mass by abdominal computed tomography (CT). FNA by transesophageal endoscopic ultrasonography demonstrated atypical cells conclusive for malignancy and consistent with metastatic renal cell carcinoma based on cytomorphology, histochemical lipid positivity, and immunohistochemical positivity for cytokeratin, vimentin, and renal cell carcinoma marker. Repeat CT with and without arteriovenous contrast demonstrated bilateral renal cysts, including a 0.9 × 0.8-cm lesion on the left with significant enhancement. Splenectomy confirmed the radiological and cytological findings, and left kidney exploration and nephrectomy demonstrated a small (1.5 cm) lower pole renal cell carcinoma of chromophil (papillary) type, histologically similar to the splenic metastasis. This case demonstrates the diagnostic importance of interdisciplinary involvement (oncology, radiology, gastroenterology, pathology, and general and urologic surgery); cytomorphology; histochemistry, including fat stain on frozen cell block; and immunohistochemistry, including the recently developed renal cell carcinoma marker.

ISSN:0002-9629    

出版商:OVID    

年代:2003

数据来源: OVID